Provider Demographics
NPI:1265686471
Name:ROGER W. SCOTT, DC
Entity Type:Organization
Organization Name:ROGER W. SCOTT, DC
Other - Org Name:SCOTT CHIROPRACTIC OFFICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-254-8020
Mailing Address - Street 1:1340 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1244
Mailing Address - Country:US
Mailing Address - Phone:585-254-8020
Mailing Address - Fax:585-254-7370
Practice Address - Street 1:1340 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1244
Practice Address - Country:US
Practice Address - Phone:585-254-8020
Practice Address - Fax:585-254-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18568AMedicare PIN